Healthcare Provider Details

I. General information

NPI: 1760758759
Provider Name (Legal Business Name): HOUSE OF PFROSPERITY EVERLASTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 MINNESOTA AVE SE
WASHINGTON DC
20019-1127
US

IV. Provider business mailing address

2918 MINNESOTA AVE SE
WASHINGTON DC
20019-1127
US

V. Phone/Fax

Practice location:
  • Phone: 202-629-2964
  • Fax: 202-629-4953
Mailing address:
  • Phone: 202-629-2964
  • Fax: 202-629-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302546
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. CURTRINA HOSTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-639-2964